Deoxyhemoglobin from patients homozygous for sickle-cell anemia (deoxyhb S) aggregates into long straight fibers. These may extend through most of the length of the sickled cell, forming either square or hexagonally packed bundles with lattice constants of 170-180 A. Each fiber is a tube made up of six thin filaments, which are wound around the tubular surface with a helical pitch of about 3000 A. Each filament is a string of single hemoglobin molecules linked end to end at intervals of 62 A in dry and 64 A in wet fibers. Molecules in neighboring filaments are in longitudinal register so that they form flat hexagonal rings; these rings are stacked so that successive ones are rotated about the fiber axis by 7.3°. The whole structure repeats after about eight rings. In this structure each molecule makes contact with four neighbors. The likely orientation of the molecules and points of contact between them are discussed. Similar filaments are also observed in normal deoxygenated erythrocytes, but in much lower concentration and aggregated into fibers of irregular diameter. No filaments appear in oxygenated sickle, or normal, adult cells, nor in oxygenated or deoxygenated fetal cells.Sickle-cell anemia is due to a mutation in the globin gene that causes the replacement of one pair of amino-acid residues in the # chains [Glu A3(6),0 Val]. This replacement leaves the solubility of the abnormal hemoglobin in its oxygenated form (oxyhb S) unchanged, but drastically reduces the solubility of deoxyhb S so that it precipitates in the erythrocytes, causing them to become elongated and rigid. The deformation and stiffness of the erythrocytes is the primary cause of the disease and is the feature that distinguishes sicklecell anemia from the anemias caused by other abnormal hemoglobins. If a method could be found of preventing the precipitation of deoxyhb 5, it might lead to a possible therapy.We are approaching this problem by a structural study of the deoxyhb S precipitate.In sickled cells and in cell-free solutions deoxyhb S has been reported to aggregate into fibers with diameters of between 140 and 170 A (1)(2)(3)(4)(5)20). Oriented preparations give x-ray fiber diagrams with a marked periodicity of 64 A along the fiber axis (6). We wish to report electron microscope studies of thin sections of sickled cells and of deoxyhb S that show the general arrangement of the fibers. These are followed by studies of negatively stained preparations in which the arrangement of the individual hemoglobin molecules is resolved, and by further x-ray diffraction work.Several features of the x-ray fiber diagrams can be explained from our findings, but the stereochemical mechanism of aggregation remains to be discovered. METHODSFor electron microscopy of thin sections, deoxygenated sickled cells and ultracentrifuge pellets of deoxyhb S were prepared as described in refs. 3 and 5.Negatively stained specimens of deoxyhb S were obtained by deoxygenating washed erythrocytes from a sickle-cell homozygote suspended in 0.1 M NaCl-1 mM 2,3-...
Direct analyses of solid phase formed by deoxygenating solutions of sickle-cell hemoglobin (Hb S) in the presence of certain other hemoglobin species show that hemoglobins A and C can participate in the filamentous fine structure characteristic of the sickling phenomenon. In contrast, fetal hemoglobin (Hb F) is nearly completely excluded.
Venous blood removed anaerobically from patients with sickle-cell anemia was transferred immediately into fixative, thus precluding significant loss or gain of oxygen by the cells. Electron microscopy demonstrated an intraerythrocytic fibrillar fine structure similar to that described in prior studies on erythrocytes sickled by deoxygenation in vitro. Observations reported here lead to these conclusions: (a) explanations of the sickling process derived from in vitro experimentation may with validity be applied to sickling in vivo; and (b) the term "sickled" must be used with caution: a sickle-shaped membrane does not necessarily endose Hb S in filamentous form.
Fixatives having either oxidizing or reducing properties were tested in a technic designed to preserve morphologic characteristics of circulating Hb SS erythrocytes. Red cells with cytoplasmic filaments presumably composed of deoxygenated Hb S were found at random by electron microscopy in all preparations. Glutaraldehyde provided the best preservation and was used in subsequent experiments. Venous blood from Hb SS patients was separated by ultracentrifugation into fractions rich in ISC and rich in non-ISC. The two types of erythrocytes, either oxygenated or deoxygenated, were morphologically distinct; and the aberrant appearance of ISC membranes suggested structural damage. Deoxygenation of non-ISC was associated with loose arrangements of filaments demonstrating a tendency to lie parallel within cell protuberances and in cells’ long axes. Cytoplasm of ISC, devoid of detail when oxygenated, acquired a characteristic filamentous fine structure when deoxygenated: the filament pattern implied either i) a molecular organization of hemoglobin within oxygenated ISC invisible in the electron microscope, or ii) filament formation along paths of least resistance in these irreversibly deformed cells. Behavior of ISC in a magnetic field favored the latter explanation. These observations are consistent with at least two sequences possibly associated with reversible sickling: filament formation leads to cell distortion, or cell distortion dictates filament arrangement. Both sequences may operate, each augmenting the other. In contrast, permanent deformation of cell shape known as irreversible sickling appears to be the morphologic contribution of membranes presumably damaged during periods of prolonged sequestration.
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